Provider Demographics
NPI:1164460077
Name:SIMONMED IMAGING, INCORPORATED
Entity Type:Organization
Organization Name:SIMONMED IMAGING, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-809-4829
Mailing Address - Street 1:6900 EAST CAMELBACK ROAD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-809-4829
Mailing Address - Fax:623-322-6147
Practice Address - Street 1:9201 EAST MOUNTAIN VIEW ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5140
Practice Address - Country:US
Practice Address - Phone:602-714-6160
Practice Address - Fax:602-714-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0729440OtherBCBS IDENTIFIER
AZ0763418Medicaid
AZ763418Medicaid
AZ0763418Medicaid
AZ763418Medicaid